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General NPI Number Information
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NPI Number | 1942680731
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Entity Type | Individual
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Provider Name | JIMMY N. OTERO C-SA
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Gender | Male
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 5079 SW 103RD AVE
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City | COOPER CITY
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State | FL
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Zip | 33328-4900
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Country | US
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Telephone | 954-534-4855
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Fax | 954-252-4073
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Provider Business Mailing Address
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Address Line | 5079 SW 103RD AVE
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City | COOPER CITY
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State | FL
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Zip | 33328-4900
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Country | US
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Telephone | 954-534-4855
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Fax | 954-252-4073
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 15-345
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License Number State | CO
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